Progression of Tricuspid Regurgitation After Cardiac Implantable Electronic Device Implantation and Its Impact on Mortality and Hospitalization: A Single-Center Cohort Study.

Abstract

Introduction: Tricuspid regurgitation (TR) progression is a recognized complication of cardiac implantable electronic device (CIED) implantation, yet its prognostic impact on long-term clinical outcomes remains incompletely defined.

Methods and results: In this single-center retrospective cohort, 303 patients undergoing CIED implantation between 2005 and 2023 were followed for a median of 4.8 years. TR severity was assessed echocardiographically at baseline and 12 months. The primary endpoint was TR progression (≥ 1-grade worsening); secondary endpoints were all-cause mortality, cardiovascular hospitalization, their composite, and progression to severe TR, analyzed by Kaplan-Meier and Cox regression. TR progressed in 103 patients (34.0%), regressed in 33 (10.9%), and remained stable in 167 (55.1%), a net rightward shift (p < 0.001). Progression differed by device type (p = 0.031): among the larger subgroups, VVI-ICD showed the greatest net progression (31.8% worsened vs. 6.9% improved; p < 0.001) and CRT-D the highest regression (18.8%). During follow-up, 67 patients (22.1%) died and 164 (54.1%) were hospitalized. Overall TR progression was not independently associated with mortality (HR 1.118, p = 0.693) but independently predicted cardiovascular hospitalization (HR 1.640, p = 0.003) and the composite endpoint (HR 1.480, p = 0.014). On unadjusted analysis, progression specifically to severe TR (n = 15) was associated with increased mortality (HR 1.99, p = 0.024) and cardiovascular hospitalization (HR 2.45, p < 0.001).

Conclusion: TR progression occurs in approximately one-third of CIED recipients within the first year and independently predicts cardiovascular hospitalization. Progression to severe TR identifies a higher-risk subset, supporting routine post-implant echocardiographic surveillance.